Estradiol interactions

Estradiol (Estrace, Climara, Vivelle-Dot), an estrogen has 150 documented interactions across the FDA labels and fact sheets we index: 17 major, 99 moderate, 25 minor, and 9 where a label reports no significant interaction. Each entry below quotes the sentence behind it. This drug page is a starting point, not a verdict for your situation.

Major interactions (17)

  • Anastrozolearomatase inhibitorMajor

    Estrogen Estrogen-containing therapies should not be used with ARIMIDEX as they may diminish its pharmacological action. (Anastrozole label, Drug interactions)

  • …increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 79 years of age) during 5 years of treatment with oral conjugated estrogens (CE 0.625 mg) combined with medroxyprogesterone acetate (MPA 2.5 mg) relative to placebo [see CLINICAL PHARMACOLOGY , Clinical Studies ]. (Estradiol label, Boxed warning)

  • Drospirenone and ethinyl estradioloral contraceptiveMajor

    CARDIOVASCULAR AND OTHER RISKS Estrogens and progestins should not be used for the prevention of cardiovascular disease [see WARNINGS , Cardiovascular disorders ]. (Estradiol label, Boxed warning)

  • GriseofulvinantifungalMajor

    Women taking estrogen-containing oral contraceptives may be at increased risk of becoming pregnant while on griseofulvin (see also PRECAUTIONS, Drug Interactions ) . (Griseofulvin label, Contraindications)

  • LevonorgestrelprogestinMajor

    CARDIOVASCULAR AND OTHER RISKS Estrogens and progestins should not be used for the prevention of cardiovascular disease [see WARNINGS , Cardiovascular disorders ]. (Estradiol label, Boxed warning)

  • CARDIOVASCULAR AND OTHER RISKS Estrogens and progestins should not be used for the prevention of cardiovascular disease [see WARNINGS , Cardiovascular disorders ]. (Estradiol label, Boxed warning)

  • MedroxyprogesteroneprogestinMajor

    …increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 79 years of age) during 5 years of treatment with oral conjugated estrogens (CE 0.625 mg) combined with medroxyprogesterone acetate (MPA 2.5 mg) relative to placebo [see CLINICAL PHARMACOLOGY , Clinical Studies ]. (Estradiol label, Boxed warning)

  • MegestrolprogestinMajor

    CARDIOVASCULAR AND OTHER RISKS Estrogens and progestins should not be used for the prevention of cardiovascular disease [see WARNINGS , Cardiovascular disorders ]. (Estradiol label, Boxed warning)

  • NorethindroneprogestinMajor

    CARDIOVASCULAR AND OTHER RISKS Estrogens and progestins should not be used for the prevention of cardiovascular disease [see WARNINGS , Cardiovascular disorders ]. (Estradiol label, Boxed warning)

  • CARDIOVASCULAR AND OTHER RISKS Estrogens and progestins should not be used for the prevention of cardiovascular disease [see WARNINGS , Cardiovascular disorders ]. (Estradiol label, Boxed warning)

  • Norgestimate and ethinyl estradioloral contraceptiveMajor

    CARDIOVASCULAR AND OTHER RISKS Estrogens and progestins should not be used for the prevention of cardiovascular disease [see WARNINGS , Cardiovascular disorders ]. (Estradiol label, Boxed warning)

  • ProgesteroneprogestinMajor

    CARDIOVASCULAR AND OTHER RISKS Estrogens and progestins should not be used for the prevention of cardiovascular disease [see WARNINGS , Cardiovascular disorders ]. (Estradiol label, Boxed warning)

  • Raloxifeneselective estrogen receptor modulatorMajor

    Concomitant Use with Systemic Estrogens : Not recommended. (Raloxifene label, Warnings and precautions)

  • St. John's wortHerbal and supplementMajor

    St. John's wort can make birth control pills less effective. (NCCIH, St. John's Wort)

  • Tizanidinemuscle relaxantMajor

    Moderate or Weak CYP1A2 Inhibitors Concomitant use of Zanaflex with moderate or weak CYP1A2 inhibitors (e.g., zileuton, antiarrhythmics [amiodarone, mexiletine, propafenone, and verapamil], cimetidine, famotidine, oral contraceptives, acyclovir, and ticlopidine) should be avoided. (Tizanidine label, Drug interactions)

  • Tranexamic acidantifibrinolyticMajor

    Concomitant use of combined hormonal contraceptives ( 4.1 ) (Tranexamic acid label, Contraindications)

  • Voriconazoleazole antifungalMajor

    John's Wort (CYP450 inducer; P-gp inducer) Significantly Reduced Contraindicated Oral Contraceptives containing ethinyl estradiol and norethindrone (CYP2C19 Inhibition) Increased Monitoring for adverse reactions and toxicity related to voriconazole is recommended for concomitant administration with oral contraceptives. (Voriconazole label, Drug interactions)

Moderate interactions (99)

  • AmiodaroneantiarrhythmicModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • Amoxicillinpenicillin antibioticModerate

    Following administration of ampicillin or amoxicillin to pregnant women, a transient decrease in plasma concentration of total conjugated estriol, estriol-glucuronide, conjugated estrone, and estradiol has been noted. (Amoxicillin label, Drug interactions)

  • Amoxicillin and clavulanatepenicillin antibioticModerate

    Following administration of amoxicillin to pregnant women, a transient decrease in plasma concentration of total conjugated estriol, estriol-glucuronide, conjugated estrone, and estradiol has been noted. (Amoxicillin and clavulanate label, Drug interactions)

  • Ampicillinpenicillin antibioticModerate

    Oral Contraceptives : May be less effective and increased breakthrough bleeding may occur. (Ampicillin label, Drug interactions)

  • AprepitantCYP3A4 inhibitorModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • AtorvastatinstatinModerate

    Oral Contraceptives: May increase plasma levels of norethindrone and ethinyl estradiol; consider this effect when selecting an oral contraceptive ( 7.3 ). (Atorvastatin label, Drug interactions)

  • BeclomethasonecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • BetamethasonecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • BosentanCYP3A4 inducerModerate

    Hormonal contraceptives: TRACLEER use decreases contraceptive exposure and reduces effectiveness ( 7.2 ). (Bosentan label, Drug interactions)

  • BudesonidecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • Budesonide and formoterolcorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • CarbamazepineanticonvulsantModerate

    John's Wort preparations (Hypericum perforatum), phenobarbital, carbamazepine, and rifampin may reduce plasma concentrations of estrogens, possibly resulting in a decrease in therapeutic effects and/or changes in the uterine bleeding profile. (Estradiol label, Drug interactions)

  • CenobamateanticonvulsantModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • Cholestyraminebile acid sequestrantModerate

    Drug Interactions Cholestyramine for Oral Suspension USP may delay or reduce the absorption of concomitant oral medication such as phenylbutazone, warfarin, thiazide diuretics (acidic), or propranolol (basic), as well as tetracycline, penicillin G, phenobarbital, thyroid and thyroxine preparations, estrogens and progestins, and digitalis. (Cholestyramine label, Drug interactions)

  • CimetidineH2 blockerModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • Clarithromycinmacrolide antibioticModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • ClobetasolcorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • Colesevelambile acid sequestrantModerate

    Concomitant use with colesevelam hydrochloride may decrease the exposure of the following drugs: Drugs with a narrow therapeutic index (e.g., cyclosporine), phenytoin, thyroid hormone replacement therapy, warfarin, oral contraceptives containing ethinyl estradiol and norethindrone, olmesartan medoxomil, and sulfonylureas (glimepiride, glipizide, glyburide). (Colesevelam label, Drug interactions)

  • CyclosporineimmunosuppressantModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • Deferasiroxiron supplementModerate

    …budesonide, buspirone, conivaptan, cyclosporine, darifenacin, darunavir, dasatinib, dihydroergotamine, dronedarone, eletriptan, eplerenone, ergotamine, everolimus, felodipine, fentanyl, hormonal contraceptive agents, indinavir, fluticasone, lopinavir, lovastatin, lurasidone, maraviroc, midazolam, nisoldipine, pimozide, quetiapine, quinidine, saquinavir, sildenafil,… (Deferasirox label, Drug interactions)

  • DesonidecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • DeutetrabenazineVMAT2 inhibitorModerate

    Chronic increase in serum prolactin levels (although not evaluated in the AUSTEDO XR, AUSTEDO, or tetrabenazine development programs) has been associated with low levels of estrogen and increased risk of osteoporosis. (Deutetrabenazine label, Warnings and precautions)

  • DexamethasonecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • Diltiazemcalcium channel blockerModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • Divalproex (valproate)anticonvulsantModerate

    Aspirin, carbapenem antibiotics, estrogen-containing hormonal contraceptives, methotrexate: Monitoring of valproate concentrations is recommended ( 7.1 ) (Divalproex (valproate) label, Drug interactions)

  • DolutegravirantiretroviralModerate

    …following drugs can be coadministered with dolutegravir without a dose adjustment: atazanavir/ritonavir, darunavir/ritonavir, elbasvir/grazoprevir, methadone, midazolam, omeprazole, oral contraceptives containing norgestimate and ethinyl estradiol, prednisone, rifabutin, rilpivirine, sofosbuvir/velpatasvir, and tenofovir [see Clinical Pharmacology ( 12.3 )] . (Dolutegravir label, Drug interactions)

  • DronedaroneantiarrhythmicModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • DuloxetineSNRIModerate

    Therefore, an increase or decrease in the metabolism of CYP3A substrates (e.g., oral contraceptives and other steroidal agents) resulting from induction or inhibition is not anticipated, although clinical studies have not been performed. (Duloxetine label, Drug interactions)

  • Elexacaftor, tezacaftor, and ivacaftorModerate

    For patients with CF taking hormonal contraceptives who develop rash, consider interrupting TRIKAFTA and hormonal contraceptives. (Elexacaftor, tezacaftor, and ivacaftor label, Drug interactions)

  • Erythromycinmacrolide antibioticModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • EslicarbazepineanticonvulsantModerate

    Hormonal Contraceptives: APTIOM may decrease the effectiveness of hormonal contraceptives. (Eslicarbazepine label, Drug interactions)

  • EverolimusimmunosuppressantModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • FelbamateanticonvulsantModerate

    Effects of Felbatol ® on Low-Dose Combination Oral Contraceptives A group of 24 nonsmoking, healthy white female volunteers established on an oral contraceptive regimen containing 30 µg ethinyl estradiol and 75 µg gestodene for at least 3 months received 2400 mg/day of felbamate from midcycle (day 15) to midcycle (day 14) of two consecutive oral contraceptive… (Felbamate label, Drug interactions)

  • FlibanserinCNS depressantModerate

    Weak CYP3A4 Inhibitors Examples Oral contraceptives, cimetidine, fluoxetine, ginkgo, ranitidine Clinical Implications The concomitant use of ADDYI with multiple weak CYP3A4 inhibitors may increase the risk of adverse reactions. (Flibanserin label, Drug interactions)

  • Fluconazoleazole antifungalModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • FludrocortisonecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • FluocinonidecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • FluticasonecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • Fluticasone and salmeterolcorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • GabapentinanticonvulsantModerate

    Oral Contraceptive Based on AUC and half-life, multiple-dose pharmacokinetic profiles of norethindrone and ethinyl estradiol following administration of tablets containing 2.5 mg of norethindrone acetate and 50 mcg of ethinyl estradiol were similar with and without coadministration of gabapentin (400 mg three times a day; N=13). (Gabapentin label, Drug interactions)

  • GlimepiridesulfonylureaModerate

    …somatropin, protease inhibitors, atypical antipsychotic medications (e.g., olanzapine and clozapine), barbiturates, diazoxide, laxatives, rifampin, thiazides and other diuretics, corticosteroids, phenothiazines, thyroid hormones, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics (e.g., epinephrine, albuterol, terbutaline), and isoniazid. (Glimepiride label, Drug interactions)

  • GlipizidesulfonylureaModerate

    …GLUCOTROL XL, leading to worsening glycemic control: atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline),… (Glipizide label, Drug interactions)

  • GrapefruitFood and drinkModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • HalobetasolcorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • HydrocortisonecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • ImatinibCYP3A4 inhibitorModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • Insulin aspartinsulinModerate

    …Glucose Lowering Effect of Insulin Aspart Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline),… (Insulin aspart label, Drug interactions)

  • Insulin degludecinsulinModerate

    …Glucose Lowering Effect of Insulin Degludec Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline),… (Insulin degludec label, Drug interactions)

  • Insulin detemirinsulinModerate

    …Blood Glucose Lowering Effect of LEVEMIR Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline),… (Insulin detemir label, Drug interactions)

  • Insulin glargineinsulinModerate

    …Lowering Effect of Insulin Glargine-yfgn Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline),… (Insulin glargine label, Drug interactions)

  • Insulin lisproinsulinModerate

    …Blood Glucose Lowering Effect of LYUMJEV Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline),… (Insulin lispro label, Drug interactions)

  • IsoniazidantibioticModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • Itraconazoleazole antifungalModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • IvacaftorCYP3A4 inhibitorModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • Ketoconazoleazole antifungalModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • LamotrigineanticonvulsantModerate

    Concomitant Use with Estrogen-Containing Products, Including Oral Contraceptives Some estrogen-containing oral contraceptives have been shown to decrease serum concentrations of lamotrigine [see Clinical Pharmacology ( 12.3 )] . (Lamotrigine label, Warnings and precautions)

  • LeflunomideimmunosuppressantModerate

    Effect on Oral Contraceptives Teriflunomide may increase the systemic exposures of ethinylestradiol and levonorgestrel. (Leflunomide label, Drug interactions)

  • Levothyroxinethyroid hormoneModerate

    Hypothyroidism Estrogen administration leads to increased thyroid-binding globulin (TBG) levels. (Estradiol label, Precautions)

  • Liothyroninethyroid hormoneModerate

    Hypothyroidism Estrogen administration leads to increased thyroid-binding globulin (TBG) levels. (Estradiol label, Precautions)

  • Methimazoleantithyroid drugModerate

    Hypothyroidism Estrogen administration leads to increased thyroid-binding globulin (TBG) levels. (Estradiol label, Precautions)

  • MethylprednisolonecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • Mirabegronbeta-adrenergic agonistModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • MometasonecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • MycophenolateimmunosuppressantModerate

    MYHIBBIN may reduce effectiveness of oral contraceptives. (Mycophenolate label, Drug interactions)

  • NintedanibModerate

    Advise women taking oral hormonal contraceptives experiencing vomiting, diarrhea, or other conditions where the drug absorption may be reduced to use alternative highly effective contraception. (Nintedanib label, Warnings and precautions)

  • Nirmatrelvir and ritonavirantiviralModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • OxcarbazepineanticonvulsantModerate

    Oral Contraceptive: TRILEPTAL may decrease the effectiveness of hormonal contraceptives ( 7.3 ) (Oxcarbazepine label, Drug interactions)

  • PalbociclibCYP3A4 inhibitorModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • PerampanelanticonvulsantModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • PhenobarbitalbarbiturateModerate

    John's Wort preparations (Hypericum perforatum), phenobarbital, carbamazepine, and rifampin may reduce plasma concentrations of estrogens, possibly resulting in a decrease in therapeutic effects and/or changes in the uterine bleeding profile. (Estradiol label, Drug interactions)

  • Phentermine and topiramateCNS stimulantModerate

    Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)

  • PhenytoinanticonvulsantModerate

    …omeprazole Sulfonamides Sulfamethizole, sulfaphenazole, sulfadiazine, sulfamethoxazole-trimethoprim Other Acute alcohol intake, amiodarone, chloramphenicol, chlordiazepoxide, disulfiram, estrogen, fluvastatin, isoniazid, methylphenidate, phenothiazines, salicylates, ticlopidine, tolbutamide, trazodone, warfarin Drugs that may decrease phenytoin serum levels Antacids… (Phenytoin label, Drug interactions)

  • PitolisantQT-prolonging drugModerate

    Sensitive CYP3A4 Substrates (including hormonal contraceptives): WAKIX may reduce effectiveness of sensitive CYP3A4 substrates. (Pitolisant label, Drug interactions)

  • Posaconazoleazole antifungalModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • PrednisolonecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • PrednisonecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • Propylthiouracilantithyroid drugModerate

    Hypothyroidism Estrogen administration leads to increased thyroid-binding globulin (TBG) levels. (Estradiol label, Precautions)

  • RanolazineQT-prolonging drugModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • RifampinantibioticModerate

    John's Wort preparations (Hypericum perforatum), phenobarbital, carbamazepine, and rifampin may reduce plasma concentrations of estrogens, possibly resulting in a decrease in therapeutic effects and/or changes in the uterine bleeding profile. (Estradiol label, Drug interactions)

  • RiluzoleModerate

    The concomitant use of strong or moderate CYP1A2 inhibitors (e.g., ciprofloxacin, enoxacin, fluvoxamine, methoxsalen, mexiletine, oral contraceptives, thiabendazole, vemurafenib, zileuton) with TIGLUTIK may increase the risk of TIGLUTIK - associated adverse reactions [see Clinical Pharmacology (12.3) ]. (Riluzole label, Drug interactions)

  • RitonavirantiretroviralModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • RoflumilastPDE4 inhibitorModerate

    Oral Contraceptives Containing Gestodene and Ethinyl Estradiol The co-administration of DALIRESP (500 mcg) with oral contraceptives containing gestodene and ethinyl estradiol may increase roflumilast systemic exposure and may result in increased side effects. (Roflumilast label, Drug interactions)

  • Ropiniroledopamine agonistModerate

    Estrogens Population pharmacokinetic analysis revealed that higher doses of estrogens (usually associated with hormone replacement therapy) reduced the clearance of ropinirole. (Ropinirole label, Drug interactions)

  • Suvorexantsedative-hypnoticModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • TacrolimusimmunosuppressantModerate

    Mild or Moderate CYP3A Inhibitors: Clotrimazole, antibiotics (e.g., verapamil, diltiazem, nifedipine, nicardipine), amiodarone, danazol, ethinyl estradiol, cimetidine, lansoprazole and omeprazole May increase tacrolimus whole blood trough concentrations and increase the risk of serious adverse reactions (e.g., neurotoxicity, QT prolongation) [see Warnings and… (Tacrolimus label, Drug interactions)

  • Tamoxifenselective estrogen receptor modulatorModerate

    Hypercalcemia in Patients with Metastatic Breast Cancer As with other additive hormonal therapy (estrogens and androgens), hypercalcemia has been reported in some breast cancer patients with bone metastases within a few weeks of starting treatment with tamoxifen. (Tamoxifen label, Warnings and precautions)

  • TeriflunomideimmunosuppressantModerate

    Effect of AUBAGIO on Oral Contraceptives AUBAGIO may increase the systemic exposures of ethinylestradiol and levonorgestrel. (Teriflunomide label, Drug interactions)

  • TetrabenazineVMAT2 inhibitorModerate

    Chronic increase in serum prolactin levels (although not evaluated in the tetrabenazine development program) has been associated with low levels of estrogen and increased risk of osteoporosis. (Tetrabenazine label, Warnings and precautions)

  • TheophyllinemethylxanthineModerate

    Estrogen Estrogen containing oral contraceptives decrease theophylline clearance in a dose-dependent fashion. (Theophylline label, Drug interactions)

  • Ticagrelorantiplatelet agentModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • TirzepatideGLP-1 receptor agonistModerate

    Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

  • Tobacco and smokingTobacco and cannabisModerate

    Risk factors for arterial vascular disease (e.g., hypertension, diabetes mellitus, tobacco use, hypercholesterolemia, and obesity) and/or venous thromboembolism (e.g., personal history or family history of VTE, obesity, and systemic lupus erythematosus) should be managed appropriately. a. (Estradiol label, Warnings)

  • TocilizumabimmunosuppressantModerate

    Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)

  • TopiramateanticonvulsantModerate

    Patients taking estrogen-containing or progestin-only contraceptives should be asked to report any change in their bleeding patterns. (Topiramate label, Drug interactions)

  • TriamcinolonecorticosteroidModerate

    Other binding proteins may be elevated in serum (i.e., corticosteroid binding globulin (CBG), sex hormone binding globulin (SHBG)) leading to increased total circulating corticosteroids and sex steroids, respectively. (Estradiol label, Precautions)

  • UrsodiolModerate

    Drugs Affecting Lipid Metabolism Estrogens, oral contraceptives, and clofibrate (and perhaps other lipid-lowering drugs) increase hepatic cholesterol secretion and encourage cholesterol gallstone formation and hence may counteract the effectiveness of URSO 250 and URSO Forte. (Ursodiol label, Drug interactions)

  • Valproic acidanticonvulsantModerate

    Aspirin, carbapenem antibiotics, estrogen-containing hormonal contraceptives: Monitoring of valproate concentrations is recommended (7.1) (Valproic acid label, Drug interactions)

  • Verapamilcalcium channel blockerModerate

    Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (Estradiol label, Drug interactions)

  • WarfarinanticoagulantModerate

    …carbamazepine, phenobarbital, rifampin CYP1A2 acyclovir, allopurinol, caffeine, cimetidine, ciprofloxacin, disulfiram, enoxacin, famotidine, fluvoxamine, methoxsalen, mexiletine, norfloxacin, oral contraceptives, phenylpropanolamine, propafenone, propranolol, terbinafine, thiabendazole, ticlopidine, verapamil, zileuton montelukast, moricizine, omeprazole, phenobarbital,… (Warfarin label, Drug interactions)

Minor mentions (25)

  • AcarboseantidiabeticMinor

    These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel-blocking drugs, and isoniazid. (Acarbose label, Drug interactions)

  • ArmodafinilCNS stimulantMinor

    Inducers of CYP3A4 such as St. (Estradiol label, Drug interactions)

  • ClobazambenzodiazepineMinor

    Inducers of CYP3A4 such as St. (Estradiol label, Drug interactions)

  • ClozapineantipsychoticMinor

    Moderate or weak CYP1A2 inhibitors include oral contraceptives and caffeine. (Clozapine label, Drug interactions)

  • Dihydroergotamineergot alkaloidMinor

    Oral Contraceptives The effect of oral contraceptives on the pharmacokinetics of Dihydroergotamine Mesylate Injection, USP has not been studied. (Dihydroergotamine label, Drug interactions)

  • Doxycyclinetetracycline antibioticMinor

    Concurrent use of tetracyclines, including doxycycline hyclate may render oral contraceptives less effective. (Doxycycline label, Drug interactions)

  • Empagliflozin and metforminSGLT2 inhibitorMinor

    These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid. (Empagliflozin and metformin label, Drug interactions)

  • GlyburidesulfonylureaMinor

    These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid. (Glyburide label, Drug interactions)

  • Glyburide and metforminsulfonylureaMinor

    Examples: Thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid. (Glyburide and metformin label, Drug interactions)

  • Insulin regular (human)insulinMinor

    Atypical Antipsychotics (e.g., olanzapine and clozapine), Corticosteroids, Danazol, Diuretics, Estrogens, Glucagon, Isoniazid, Niacin, Oral Contraceptives, Phenothiazines, Progestogens (e.g., in oral contraceptives), Protease inhibitors, Somatropin, Sympathomimetic Agents (e.g., albuterol, epinephrine, terbutaline) and Thyroid Hormones. (Insulin regular (human) label, Drug interactions)

  • IsotretinoinretinoidMinor

    Oral Contraceptives Isotretinoin Capsules did not result in clinically significant changes in the pharmacokinetics of norethindrone and ethinyl estradiol when used concomitantly with a norethindrone and ethinyl estradiol oral contraceptive [see Clinical Pharmacology ( 12.3 )]. (Isotretinoin label, Drug interactions)

  • LevetiracetamanticonvulsantMinor

    Potential pharmacokinetic interactions of or with levetiracetam were assessed in clinical pharmacokinetic studies (phenytoin, valproate, warfarin, digoxin, oral contraceptive, probenecid) and through pharmacokinetic screening in the placebo-controlled clinical studies in epilepsy patients. (Levetiracetam label, Drug interactions)

  • MetforminbiguanideMinor

    Examples: Thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid. (Metformin label, Drug interactions)

  • ModafinilCNS stimulantMinor

    Inducers of CYP3A4 such as St. (Estradiol label, Drug interactions)

  • Pilocarpinecholinergic agonistMinor

    …performed, the following concomitant drugs were used in at least 10% of patients in either or both Sjogren's efficacy studies: acetylsalicylic acid, artificial tears, calcium, conjugated estrogens, hydroxychloroquine sulfate, ibuprofen, levothyroxine sodium, medroxyprogesterone acetate, methotrexate, multivitamins, naproxen, omeprazole, paracetamol, and prednisone. (Pilocarpine label, Drug interactions)

  • Pioglitazone and metforminthiazolidinedioneMinor

    These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid. (Pioglitazone and metformin label, Drug interactions)

  • PregabalinanticonvulsantMinor

    No pharmacokinetic interactions were observed between LYRICA and carbamazepine, gabapentin, lamotrigine, oral contraceptive, phenobarbital, phenytoin, topiramate, and valproic acid. (Pregabalin label, Drug interactions)

  • PrimidoneanticonvulsantMinor

    Inducers of CYP3A4 such as St. (Estradiol label, Drug interactions)

  • RepaglinidemeglitinideMinor

    Examples: Atypical antipsychotics (e.g., olanzapine and clozapine), calcium channel antagonists, corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and… (Repaglinide label, Drug interactions)

  • RisedronatebisphosphonateMinor

    Hormone Therapy Concomitant use of Risedronate sodium delayed-release with estrogens and estrogen agonist/antagonists has not been studied. (Risedronate label, Drug interactions)

  • RufinamideanticonvulsantMinor

    Hormonal contraceptives may be less effective with BANZEL; use additional non-hormonal forms of contraception ( 7.3 ) (Rufinamide label, Drug interactions)

  • Sitagliptin and metforminDPP-4 inhibitorMinor

    Examples: Thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid. (Sitagliptin and metformin label, Drug interactions)

  • TerbinafineantifungalMinor

    There is no information available from adequate drug-drug interaction studies with the following classes of drugs: oral contraceptives, hormone replacement therapies, hypoglycemics, phenytoins, thiazide diuretics, and calcium channel blockers. (Terbinafine label, Drug interactions)

  • Tetracyclinetetracycline antibioticMinor

    Concurrent use of tetracycline may render oral contraceptives less effective. (Tetracycline label, Drug interactions)

  • ZiprasidoneantipsychoticMinor

    Oral Contraceptives In vivo studies have revealed no effect of ziprasidone on the pharmacokinetics of estrogen or progesterone components. (Ziprasidone label, Drug interactions)

No significant interaction reported (9)

  • AlosetronNo interaction

    Another study showed that alosetron had no clinically significant effect on plasma concentrations of the oral contraceptive agents ethinyl estradiol and levonorgestrel (CYP3A4 substrates). (Alosetron label, Drug interactions)

  • DarifenacinanticholinergicNo interaction

    Combination oral contraceptives Darifenacin (10 mg three times daily) had no effect on the pharmacokinetics of the combination oral contraceptives containing levonorgestrel and ethinyl estradiol [see Clinical Pharmacology (12.3)] . (Darifenacin label, Drug interactions)

  • DofetilideantiarrhythmicNo interaction

    Other Drugs: In healthy volunteers, amlodipine, phenytoin, glyburide, ranitidine, omeprazole, hormone replacement therapy (a combination of conjugated estrogens and medroxyprogesterone), antacid (aluminum and magnesium hydroxides), and theophylline did not affect the pharmacokinetics of dofetilide. (Dofetilide label, Drug interactions)

  • Emtricitabine and tenofovirantiretroviralNo interaction

    No clinically significant drug interactions have been either observed or are expected when DESCOVY is combined with the following drugs: buprenorphine, itraconazole, ketoconazole, lorazepam, methadone, midazolam, naloxone, norbuprenorphine, norgestimate/ethinyl estradiol, and sertraline. (Emtricitabine and tenofovir label, Drug interactions)

  • FesoterodineanticholinergicNo interaction

    Oral Contraceptives In the presence of fesoterodine, there are no clinically significant changes in the plasma concentrations of combined oral contraceptives containing ethinyl estradiol and levonorgestrel [see Clinical Pharmacology (12.3) ] . (Fesoterodine label, Drug interactions)

  • Montelukastleukotriene receptor antagonistNo interaction

    No dose adjustment is needed when SINGULAIR is co-administered with theophylline, prednisone, prednisolone, oral contraceptives, fexofenadine, digoxin, warfarin, gemfibrozil, itraconazole, thyroid hormones, sedative hypnotics, non-steroidal anti-inflammatory agents, benzodiazepines, decongestants, and Cytochrome P450 (CYP) enzyme inducers [see Clinical Pharmacology… (Montelukast label, Drug interactions)

  • Sofosbuvir and velpatasvirantiviralNo interaction

    …clinically significant drug interactions have been observed with the following drugs [see Clinical Pharmacology (12.3) ]: VOSEVI: cobicistat, darunavir, elvitegravir, emtricitabine, ethinyl estradiol/norgestimate, gemfibrozil, rilpivirine, ritonavir, tenofovir alafenamide, voriconazole Sofosbuvir/velpatasvir: dolutegravir, ketoconazole, raltegravir Sofosbuvir:… (Sofosbuvir and velpatasvir label, Drug interactions)

  • TiagabineanticonvulsantNo interaction

    Oral Contraceptives : Multiple dose administration of tiagabine (8 mg/day monotherapy) did not alter the pharmacokinetics of oral contraceptives in healthy women of child-bearing age. (Tiagabine label, Drug interactions)

  • Zafirlukastleukotriene receptor antagonistNo interaction

    In a single-blind, parallel-group, 3-week study in 39 healthy female subjects taking oral contraceptives, 40 mg twice daily of zafirlukast had no significant effect on ethinyl estradiol plasma concentrations or contraceptive efficacy. (Zafirlukast label, Precautions)

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Not medical advice. Severity reflects the label's wording, not your circumstances. A "major" flag can be routine under supervision and a "minor" one can matter at high doses. Ask a pharmacist.